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Discusses options for managing perimenopause- and menopause-related hot flashes. Explains what hot flashes are. Discusses lifestyle changes that may help hot flashes. Looks at hormone therapy (HT) and treatment with medicines and herbs.

Menopause: Managing Hot Flashes

Introduction

Most women experience
hot flashes at some point before or after
menopause, when their
estrogen levels are declining. While some women have
few to no hot flashes, others have them numerous times each day. If hot flashes
are disrupting your sleep or daily life, you are no doubt looking for relief.
Fortunately, you have a number of self-care and medical treatment options that
can help you manage your symptoms.

No matter how disruptive and frustrating they
may be, hot flashes are not a sign of a medical problem. They are a normal
response to natural hormonal changes in your body. Hot flashes usually subside
after the first or second year following menopause, when estrogen levels
stabilize at a low level.

Tobacco use, heavy alcohol use, and stress tend to make hot
flashes worse. By avoiding these risk factors, exercising regularly, and eating
well, you can prevent or reduce hot flashes.

The body-mind
connection is a powerful element of hot flashes and emotional symptoms.
Rhythmic breathing exercises (paced respiration), which help you meditate and
relax, may reduce your hot flashes.

Treatments that may either
reduce or stop moderate to severe hot flashes include short-term, low-dose
estrogen (hormone therapy), certain antidepressant and blood
pressure medicines, and the herb black cohosh.

How can I manage hot flashes?

You can manage hot
flashes by making certain lifestyle choices. You can also take daily medicine.
Some measures help prevent or reduce hot flashes, and others can make you more
comfortable when you're having a hot flash. If you are looking for additional
treatment measures, you have a few options to choose from.

Lifestyle choices for preventing or reducing hot flashes

Eat smaller, more frequent meals to avoid the heat
generated by digesting large amounts of food.

Make healthy eating a priority.

Do not smoke or
use other forms of tobacco.

Stay cool.

Keep your environment cool, or use a
fan.

Dress in layers, so you can remove clothes as
needed.

Wear natural fabrics, such as cotton and
silk.

Sleep with fewer blankets.

Reduce stress.

Get regular
physical exercise.

Use relaxation techniques, such as
breathing exercises,
yoga, or
biofeedback. Using a breathing-for-relaxation exercise
called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment options for hot flashes

Short-term, low-dose
hormone therapy (HT) can reduce or stop
hot flashes and other perimenopausal symptoms by raising your body's estrogen
level. Use the lowest dose needed for the shortest possible time and have
regular checkups. This is because HT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, and dementia in a small number of women. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.1 If you have a history of cardiovascular disease or breast
cancer, avoid using estrogen for hot-flash relief—other options are available.

Estrogen-progestin birth control pills (before
menopause) can reduce or stop hot flashes and other perimenopausal symptoms by
evening out fluctuating hormones. Don't use estrogen for hot-flash relief if
you are older than 35 and smoke; have
diabetes, cardiovascular disease, or breast cancer; or
have a
family history of breast cancer.

Antidepressant medicine can reduce the number and
severity of hot flashes by improving the brain's use of serotonin, which helps
regulate body temperature. Side effects are possible.
This type of medicine is a good choice if hot flashes, irritability, or mood
swings are your only perimenopausal symptom.2

Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent.3 This type of medicine is a good choice if
hot flashes are your only perimenopausal symptom, especially if you have high
blood pressure.

Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.2

Black cohosh may reduce or prevent hot flashes,
depression, and anxiety. As with HT, have regular checkups when taking
black cohosh.

Some women eat and
drink a lot of soy to even out hot flashes and other perimenopausal symptoms.
So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.4

References

Citations

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.

North American Menopause Society (2011). The role of soy isoflavones in menopausal health: Report of the North American Menopause Society. Menopause, 18(7): 732–753.

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